Provider Demographics
NPI:1023129079
Name:BROWN, DELORISE (MD)
Entity type:Individual
Prefix:DR
First Name:DELORISE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 FOREST HILLS BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-4348
Mailing Address - Country:US
Mailing Address - Phone:216-451-2030
Mailing Address - Fax:216-451-2027
Practice Address - Street 1:1831 FOREST HILLS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4348
Practice Address - Country:US
Practice Address - Phone:216-451-2030
Practice Address - Fax:216-451-2027
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039059B207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH140611OtherANTHEM OHIO
OH0403717OtherUNITED HEALTHCARE
OH350477OtherWELLCARE
OH0420315Medicaid
OH004080259OtherAETNA
OH110212700OtherRAILROAD MEDICARE
OH34186002300OtherOHIO BWC
OH34186002300OtherOHIO BWC
OH140611OtherANTHEM OHIO